Every public-policy problem can be defined in terms of its empirical (“facts”) and normative (“values”) dimensions and the interrelationship between them. An understanding of the connection between facts and values at the foundation of the home care policy debate in the Canadian health-care system is developed through the application of an analytical framework based on the concept of “narrative frame” analysis. The literature on home care policy reports and recommendations is examined within this conceptual structure – including especially publications and reports from the federal government, national organizations, and the aging and disability communities. Finally, observations and conclusions about the significance of home care policy discourse, and of the differences between the aging and disability constituencies in this debate, are offered as a guide for deconstructing the public-policy process.

Two challenges facing nursing-home care today are understanding the concept of quality of life as it relates to cognitively impaired residents and finding effective ways to ensure that it is achieved. Canadian director Allan King's documentary, Memory for Max, Claire, Ida and Company, filmed at Baycrest, captures a method for enhancing the quality of life of six cognitively impaired residents. While the film suggests an intervention model implemented by volunteers, there are challenges unique to institution-based programs (i.e., the recruitment and retention of volunteers). One of the challenges is the fear that volunteers may experience when interacting with the cognitively impaired. We conducted a pilot study of a model for training volunteers to provide friendly visiting and evaluated the impact on the participating residents. Observational accounts of volunteer–resident interactions and seven volunteer interviews were analysed and yielded several themes—(a) relationship building, (b) contribution of the environment, (c) preserving personhood, (d) resident-centred presence and the quality of the moment—and several themes related to the volunteers' role and their perceived impact on the residents. Discussed are the implications for volunteer programs in long-term health care settings.

A descriptive cross-sectional study was conducted to (a) determine the prevalence of need for wheel-chair seating intervention in two long-term care facilities in Vancouver, BC, (b) determine the extent of the residents' independent mobility within these facilities, and (c) explore the relationship between proper wheel-chair seating and positioning and independent mobility. The study population comprised 99 wheel-chair-using older adults. Four trained raters assessed need for seating intervention, using the Seating Identification Tool, and quantified extent and frequency of wheel-chair mobility, using the Nursing Home Life-Space Diameter. Results indicated that (a) there was a low need (overall 22%) for wheel-chair seating intervention in the two facilities, (b) half of the residents were independently mobile in their own rooms and on their units, but independent mobility decreased when greater distances needed to be travelled, and (c) the need for wheel-chair seating intervention was the only significant predictor of extent of independent mobility. These findings suggest that, where there are dedicated staff and equipment resources, the need for wheel-chair seating intervention can be minimized and independent mobility for long-term care residents maximized.

Senescence is a time of decline; yet many seniors remain active and engaged into very old age. How and why do some seniors live long and keep well? We report the responses to this question from a representative sample of 2,783 Canadian seniors.

Overall, seniors placed primary responsibility for their long lives on their own individual practices, citing keeping active and maintaining good nutrition as the major themes. Physical illness was less significant than the will to adapt to illness and avoid further physical decline as long as possible. Francophone and anglophone respondents differed in the frequency with which they mentioned many of the themes. Francophones focused on life quality and family, while anglophones focused on the self. Systematic gender differences were also identified. Many responses validate existing theories of successful aging, and indicate that Canadian seniors are well-informed, insightful participants in the process of growing old.

Cost-effective methods have been developed to help busy emergency department (ED) staff cope with the growing number of older patients, including quick screening and assessment tools to identify those at high risk and note their specific needs. This survey, from a sample of key informants from all EDs (n=111) in the province of Quebec (participation rate of 88.2%), investigated the implementation of these tools and barriers to implementation. Questionnaires (administered either by telephone or by self-completion) included characteristics of the ED, characteristics of the respondent, use of tools, and method of implementation. Barriers to the implementation of these tools included lack of resources for screening and follow-up, misunderstandings of the difference between screening and assessment tools, and need for adaptation of the tools to the local context. Education of staff and pre-implementation adaptation and testing are needed for successful implementation.

Caregivers play a determining role in choosing treatments for persons with Alzheimer's disease. The objective of this study was to examine caregivers' willingness to have persons with Alzheimer's disease continue taking cholinesterase inhibitors in the event that any 1 of 11 adverse effects was to occur. Data were gathered via postal questionnaire from 375 caregivers in Montreal. Sixty-four per cent of caregivers responded (n = 201), and most (≥59%) were willing to continue treatment if persons with Alzheimer's disease suffered from weight loss or loss of appetite. However, most (≥53%) were not willing to continue treatment in the event of headache, dizziness, nausea, diarrhea, vomiting, drop in blood pressure, insomnia, muscle cramps, or stomach bleeding. The use of cholinesterase inhibitors by persons with Alzheimer's disease was positively associated with caregivers' willingness to accept greater numbers of adverse effects (adjusted relative risk = 1.97; 95% CI = 1.11 to 3.61). Caregivers appear to make a risk–benefit assessment when they decide whether or not care-recipients should continue pharmacotherapy in the event of adverse effects.

The paper discusses two reforms in Ontario's long-term care. The first is the commercialization of home care as a result of the implementation of a “managed competition” delivery model. The second is the Ministry of Health and Long-Term Care's privileging of “health care” over “social care” through changes to which types of home care and home support services receive public funding. It addresses the effects of these reforms on the state–non-profit relationship, and the shifting balance between public funding of health and social care. At a program level, and with few exceptions, homemaking services have been cut from home care, and home support services are more medicalized. With these changes, growing numbers of people no longer eligible to receive publicly funded home care services look for other alternatives: they draw available resources from home support, they draw on family and friend networks, they hire privately and pay out of pocket, they leave home and enter an institution, or they do without.

Little is known as yet about the impact of telesurveillance services on social participation. To document the interaction between telesurveillance services and social participation of the elderly living at home, a study was conducted in the context of a government call center employing nurses. A focus group study was realized with elders (n=4), caregivers (n=6), healthcare system practitioners and industry employees (n=7). A qualitative analysis was performed using the Disability Creation Process model and generally accepted criteria for evaluating telehealth interventions. The results showed, on the one hand, factors that facilitate the use of telesurveillance services (user's intellectual capabilities, acceptance of clinical settings, relevance of recommendations, cost of service, and accessibility) and, on the other, factors that reinforce such use (user behaviors; level of satisfaction; impact on informal caregiver; system's level of performance; technical features; and life-habit aspects such as personal transportation, sleep, housekeeping, personal care, interpersonal relationships, and recreational activities).

Purpose: The purpose of this study was to evaluate the utility and reliability of a home hazard checklist published in Health Canada, The Safe Living Guide: A Guide to Home Safety for Seniors (2003).

Methods: 76 community-dwelling seniors evaluated the guide, and inter-rater reliability was determined through comparison of ratings of seniors and experts.

Results: Findings revealed that seniors found The Safe Living Guide useful in helping them identify hazards. On the majority of items in the checklist, agreement between raters was moderate to almost perfect, with an overall reliability of 0.509.

Practice Implications: This guide can be used with confidence by seniors and community-based caregivers for evaluating hazards and identifying opportunities in order to support and prolong safe, independent living in the community.

This study explored the value undergraduate students (N = 138) attach to relationships with impaired grandparents by examining some of the reasons they visit (and do not visit) grandparents who live with conditions limiting their cognitive, physical, or psychological well-being. As part of a larger study, participants completed two checklists to indicate their reasons for visiting and not visiting their affected grandparents. Reward-based reasons were endorsed more frequently as motives for visiting than were reasons based on external constraints, family difficulties, guilt, or wanting to take advantage of the time left with their grandparents. Barriers that restricted opportunities to visit were endorsed more frequently as explanations for participants' failure to visit than were problems in the relationship itself, guilt, or severity of impairment.

While the physical correlates of knee osteoarthritis are well documented, less well documented are aspects of psychological functioning that may affect overall health and functional status. This paper describes the findings of a cross-sectional analysis that examined the strength of the relationship between selected psychological factors and the walking ability of adults with knee joint osteoarthritis. The variables assessed were pain, depression, levels of self-efficacy for pain and other-symptoms management, walking endurance, walking speed, and perceived exertion when walking. The sample, including 57 persons with unilateral and 43 persons with bilateral radiographic and symptomatic knee osteoarthritis, mean age, 69.9 ± 1 years, underwent standard assessment procedures on a single test occasion using several validated questionnaires and a series of walking tests on level ground. Bivariate and multiple regression analyses revealed that (a) higher pain and other-symptoms self-efficacy scores were associated with lower levels of pain (r = −0.29, −0.20.), perceived exertion during a walking task (r = −0.29, −0.31), and depression scores (r = −0.46, −0.54) (p < 0.001); (b) subjects with higher levels of self-efficacy for managing symptoms other than pain also recorded faster and fast speed walking velocities than those with lower self-efficacy scores (r = 0.30, 0.31) (p < 0.001); (c) self-efficacy for pain was the strongest predictor of pain intensity, and self-efficacy for symptom management was the strongest predictor of perceived exertion during walking, depression, and pain self-efficacy. Although no cause–effect relationship can be deduced from a cross-sectional analysis, these data imply that efforts to heighten self-efficacy for pain and other-symptoms management may influence the affective status, function, and effort-related perceptions of people with knee osteoarthritis quite significantly.

Physicians (N = 803) were contacted via postal survey and given two sets of efficacy measures for drug treatments in Alzheimer's disease: (a) the time that patients spend in a mild or moderate state of disease; (b) levels of modification to disease progression in the areas of cognition, behaviour, and mood, and ability to perform basic activities of daily living. Physicians reported that they would prescribe a hypothetical, new Alzheimer's disease medication if it would allow patients to remain in their current disease state for 15 (mild) or 11 (moderate) additional months. Most physicians required a permanent halt to, or some reversal of, disease progression as a prerequisite for prescribing; a few required substantial reversal. More stringent efficacy requirements were negatively associated with physicians' current prescribing of cholinesterase inhibitors to persons with Alzheimer's disease, although the effects were either small (odds ratio = 0.99) or not statistically significant at the 5 per cent level. The results suggest that physicians with stringent efficacy requirements for clinically relevant efficacy measures are less likely to prescribe cholinesterase inhibitors.

In many countries one approach to supporting family-and-friend caregivers is direct financial or monetary support. Debates about the benefits and consequences of such policies pervade the literature. Building on the premise that values underlie public policy, the paper examines four policy paradoxes in the literature and uses selected examples from an international policy analysis to illustrate the underlying objectives and values upon which many of the policies were developed. These include the responsibility to care, economic or social objectives, gender equity, and the autonomy of care receivers. The authors conclude that policy makers need to be cautious about the unintended effects of financial support policy and develop a menu of policies and services to support caregivers. Future policy development in Canada must enable legitimate choice across the life course and ensure that neither the caregiver nor the care receiver will experience short- or long-term financial consequences of his or her choice.

Several studies have demonstrated the efficacy of falls-prevention programs designed for community-dwelling seniors using randomized designs. However, little is known about the feasibility of implementing these programs under natural conditions and about the success of these programs when delivered under such conditions. The objectives of this paper are to (a) describe a multifactorial falls-prevention program (called Stand Up!) designed for independent community-dwelling seniors and (b) present the results of an analysis of the practicability of implementing this program in community-based settings. The program was implemented in the context of an effectiveness study in 10 community-based organizations in the Montreal metropolitan area. Data pertaining to the reach and delivery of the program as well as participation level show that a falls-prevention program addressing multiple risk factors can be successfully implemented in community-based settings.

Objectives: Are people 75 or over enabled to stay at home longer through annual assessments and referrals to health/social services than through assessments only or without assessments?

Design: randomized controlled trial

Participants: 520 people 75 or over living in their own homes

Intervention: Four annual RAI-HC computerized functional assessments. Intervention group 1: elders and primary caregivers received the results and were invited to take appropriate actions. Intervention group 2: elders and primary caregivers were offered referrals to health/social services.

Measurements/Outcomes: death, institutionalization, home care services, RAI-HC scores, self-rated health, perceived self-efficacy, caregiver burden

Results: By the end of the study, annual functional assessment and offers of referrals to health/social services led to a greater use of home care (6.3%) than did assessment alone (1.8%), but there were no significant differences in death rates, institutionalization, perceived self-efficacy, self-rated health status, or caregiver burden scores between groups.

Conclusion: We discovered that this was a group of healthy seniors. Multi-dimensional functional assessment is time- and labour-intensive and should be targeted at the minority of least self-reliant seniors.

Purpose: This study estimates the prevalence of problems with transportation in a sample of community-dwelling seniors residing in an urban setting and investigates the role that gender plays in the ability of seniors to remain mobile in their communities.

Design and Methods: Data collected as part of a study assessing the prevalence and consequences of unmet needs for community-based services in a random sample of 839 elderly aged 75 years and older were employed in bivariate and multivariable analyses.

Results: The prevalence of problems with transportation was 23 per cent, with 33 per cent of females and 10 per cent of males categorized as having problems with transportation. Of those subjects categorized as having problems with transportation, 88 per cent were women. In addition to being predominantly women, those who reported problems with transportation were older, in poorer health, and had lower income and income satisfaction.

Implications: Problems with transportation are an important issue facing seniors; women, in particular. These results highlight the differences in aging as experienced by women and men with respect to social effects, needs, and the significance attached to the experience.

Although family scholars conceptualize caregiving in terms of networks of carers, little attention has been given to equity within these groups. Siblings comprise a prevalent caregiving network of members who feel responsible for parent care, expect to share these responsibilities with each other, and look to each other to evaluate the fairness of their sharing. In this paper, a multidisciplinary approach is used to examine sibling views of equity in relation to disputes over giving parent care and receiving parent assets. A literary perspective is offered through analysis of stepsibling tensions depicted in the novel Family Matters. Real life disputes among biological siblings that have been pursued through the courts are also examined. Issues arising from these examples are then analysed through the lens of legal doctrines of equity. Siblings evaluating fairness undertake careful comparisons of their respective relationships with parents in terms of biological links to parents and type and extent of influence in interactions with parents.

This study investigates three principal aspects of semantic memory processing in Alzheimer's disease: word finding, knowledge of the specific and generic attributes of concepts. Semantic memory is assessed by a range of verbal and visual tasks differentiated according to their level of complexity. Our hypothesis is that the processing of these types of information is modulated by the degree of effortful processing required by the tasks. The AD patients show more important difficulties on the tasks of high level of complexity. Nevertheless, although their performances improve when the level of complexity decreases, they significantly remain lower than those of the normal older subjects. These results are discussed with regard to the models of semantic memory, with particular reference to the debate in terms of a deficit of access or storage of this system in Alzheimer disease.